What does high-functioning trauma look like?

Usually, like a woman who’s doing well. She’s good at her job. Her calendar runs, her forms get turned in early, and people bring her their problems because she handles them. What doesn’t show is how much it takes to keep all of it going.

The phrase isn’t a diagnosis. The catch is that it sounds like nothing’s getting in the way. Sometimes plenty is, in private. High achievers make up most of my practice, so this is a picture I know well.

This might not be you, and that’s an answer too. But if it does sound familiar, here’s what I’d want you to know.

Why does it cost so much?

Because you’re doing two jobs. One is the job everyone sees. The other is keeping that one going while you carry whatever else you’re carrying.

When being busy is what keeps everything standing, a free weekend can feel harder than a full week. The crash after a big push isn’t laziness. It’s what the push cost. Anyone carrying all of that would be worn out!

And no one checks on the woman who looks fine. The better you hold it together, the more alone you are with it. So a good week can still leave you wiped out. Nothing looked hard. All of it WAS.

Does it count if I turned out fine?

Maybe nothing happened that sounds like much when you try to tell it. Maybe there was no single terrible day.

Trauma isn’t measured by how dramatic the story is. SAMHSA is the federal agency for mental health and substance use. It describes trauma as an event, a series of events or a set of circumstances that a person experiences as harmful. What makes it trauma is that it leaves lasting effects on how she functions. That wording doesn’t require violence.

The CDC’s list of child abuse includes emotional abuse and neglect. Neglect means a child’s basic needs, physical and emotional, weren’t met.

Trauma isn’t a contest! Whether yours counts doesn’t depend on how anyone else’s went.

Is it PTSD? Not necessarily. PTSD is one specific diagnosis. According to the VA’s National Center for PTSD, it follows a specific kind of event: one where someone’s life was in danger, whether you went through it or saw it. Trauma is a wider word than that. It’s okay to not know what to call yours.

Why can’t anyone tell?

Being good at your job proves you’re good at your job. It proves nothing about what happened to you. Plenty of people go through hard things and do well, which is exactly why you can’t tell from looking.

We tend to take competence as the answer anyway. Your boss sees the work and doesn’t ask. Why would anyone look closer? If a full calendar proved someone was okay, no one would ever burn out!

Handling it yourself is part of what makes you good at your job. It’s also part of what keeps this out of sight. Every “you’re so strong” makes the next honest sentence a little harder to say. And nothing falls apart in a way anyone can see, so nothing makes anyone ask. Emotional neglect in particular can be hard to spot.

If you haven’t told anyone, there’s a reason. Shame is a big part of it. The more a trauma still weighs on someone, the more shame she tends to carry, often over something that was never hers to carry. Shame works quietly. It tells you to keep this to yourself. Shame, stigma and the fear of being rejected are among the biggest reasons people who’ve been through trauma don’t get help.

And if you’re the capable one, saying “I’m not okay” can feel like quitting the job of being her.

Where does it come from?

Sometimes from childhood. A child who grows up around harm or neglect can get very quick at spotting trouble. That’s the brain adapting, so she can get through the place she grew up in.

If that was you, maybe you were the kid who signed her own permission slips and still brought home straight A’s. Kids who handle everything get told how mature they are. Grown up, that kid may still have trouble telling where the coping ends and she begins.

Sometimes it comes later. Maybe a loss, a medical scare, or a marriage that went wrong. You kept going, because that’s what you do. Then the job can turn into the one place that’s still working, and keeping it that way can take everything you have.

Is therapy for someone like me?

Yes! A book or an app can help with the stress on top. It usually can’t reach what’s underneath. If anxiety is part of it too, we can work on both at once. Some of the work is going back to the first time you decided you had better handle it yourself.

I’m trained in EMDR, a structured way of working with a memory that still has a hold on you. My page on trauma and EMDR says more about how I use it.

Do you have to tell all of it? No. What we work on is decided together, and your yes comes first. We won’t spend every week on the past. You also don’t need a name for it, or a reason that sounds good enough, before you start.

One thing to notice this week

This week, see if you can catch the moment the doing-well starts. Maybe it’s the breath you take before a meeting. Maybe it’s the voice you use on one particular phone call. Maybe it’s the face you’ve set by the time you sit down at your desk.

You don’t have to change it, or take any of it off. Just notice that you did it.

If you aren’t safe at home tonight

If someone in your home is hurting you, or you aren’t safe there tonight, call 911. The same goes for a medical emergency. If tonight the trouble is your own thoughts, 988 is the crisis line. It answers a call or a text at any hour, with a counselor on the other end. My contact page has both, any hour you need them.

What happens if you write to me?

There’s a free first call, about fifteen or twenty minutes long. After that, we can meet in Cedar Park, where my office is, or online from wherever you live in Texas. The first session is about 50 minutes. It’s an interview both ways, because you are deciding about me too. My How I work page has the rest. If you would rather write than call, I answer messages myself, within two days and usually within one.

When you’re ready, request a time or write to me.

On solid ground,

Acelli